Sexual assault is a silent, violent epidemic that physically injures an estimated 2.6 million females in the U.S. ach year; 800,000 females will receive some type of health care as a result of their injuries. This competing continuation application builds on the unexpected finding that significantly fewer ano-genital injuries occurred n Black/African American women than in White/Caucasian women following both consensual and non- consensual sexual intercourse. We believe these differences can be explained by variation in visibility of injury due to skin color. If differences in visibility lead to lower observed prevalence of injury in women with dark skin, they are at a disadvantage within the healthcare and legal systems because their injuries are not treated and prosecutors are less likely to file charges. The objectives include determining: 1) if women after non-consensual sexual assault have a significantly greater prevalence, frequency, and severity of intercourse-related ano-genital injuries than women after consensual sexual intercourse; 2) if intercourse- related injuries are less likely to be identified in women of race/ethnicities with darker skin color after adjusting for biometrically-derived measures of skin color; and 3) if there is a constellation of injury types (Tears, Ecchymoses, Abrasions, Redness, Swelling, or TEARS) and severities within specific anatomical locations that best discriminates victims of sexual assault from women who have had consensual intercourse; and to create 4) an injury map and genital injury severity scale (GISS) that are empirically- derived tools that can be used by clinicians to evaluate lack of consent. We will prospectively enroll 400 Consensual Control, ethnically/racially diverse participants who will undergo a forensic exam and digital imaging following consensual sex. Data derived from the exam will be compared to data from a retrospective review of forensic records and digital images from 400 matched Non-consensual Sexual Assault Survivors. Results of refined biometric imaging techniques will allow us to: 1) create a genital injury severity scale (GISS); 2) empirically test the association between skin colorimetric variables and ano-genital injury prevalence, frequency, and severity within each study group; 3) compare Consensual and Non-consensual Groups in terms of their injury-related characteristics, controlling for skin color variables; 4) predict or differentiate Consensual versus Non-consensual Group membership using modern classification statistics; and 5) construct a predictive Injury Map with clinical utility based on the results of classification analyses. Public Health Relevance: Violence against women is a silent epidemic. The forensic exam used to collect evidence after rape needs to be equally sensitive for females with dark skin as well as females with light skin. [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable]